Cysticercosis of the central nervous system: clinical and therapeutic considerations.

Abstract

SUMMARY In a group of forty cases of cysticercosis of the central nervous system, 59% presented with intracranial hypertension due to obstructive hydrocephalus. Ventricular or cistemal cysts, and chronic cysticercus meningitis were the most common causes of hydrocephalus. Seizures occurred in 40% of the patients, in one-half of them in association with CT-detected parenchymatous cysts. In 20% of the cases progressive mental deterioration was the main clinical feature, at times associated with hydrocephalus. CT scan provided the highest diagnostic yield, being abnormal in 90% of cases. Long term prognosis was poor, with a mortality rate of 38% over a 40-month follow-up period. The most common cause of death (60%) was meningitis. CSF shunting is the treatment of choice for hydrocephalus, irrespective of its mechanism. Surgical resection is indicated in some cases with a single superficial (cortical) or posterior fossa cyst. Supratentorial cysts carry a relatively benign prognosis.The aetiology of neurocysticercosis, the biological cycle of the parasite, and the pathological lesions it provokes have been well documented.'-'°However, some aspects of the disease, such as its initial clinical manifestations, the yield of various diagnostic methods, and its treatment still remain unclear. In addition, accurate figures on outcome and long-term prognosis are not widely available. We report a group of 40 patients with cysticercosis of the central nervous system, in an attempt to clarify these questions.Forty patients with a diagnosis of neurocysticercosis were studied. Aids to diagnosis included complement fixation reaction in blood and cerebrospinal fluid (CSF), counterimmunoelectrophoresis, and intradermal reactions. These tests were positive in 32 cases. The diagnosis was verified pathologically in 18 cases, and the cause of death was verified by necropsy in 10 cases. Follow-up covered periods from 7 to 97 months (mean: 40 months) in 32 patients.

Fourth ventricle computed tomography indexes: standardisation and characteristics in neurocysticercosis

“…Psychic disturbances in neurocysticercosis, could float from mild symptoms like apathy, cognitive disturbances, alterations in the humour and memory, to more severe psychiatric pictures as dementia, depression and schizophrenia [18][19][20][21][22] . Neurological manifestations are generally associated 12,19,21 , and could be one of the signs as of ICH 12,19,23 , as of hypertensive or normal pressure hydrocephalus 19,24,25 .…”

Interleukin levels in cerebrospinal fluid from children with neurocysticercosis.

“…[1][2][3]11,12,16,[26][27][28] Although NCC has been less well-studied in children, clinical experience suggests that the clinical and inflammatory response may differ from that of adults. To our knowledge, this study is the first published description of pro-inflammatory interleukin levels in CSF from children with different forms of NCC.…”

“…6,7,[9][10][11][12] The severity of the symptoms has been related to the number of cysticerci, their localization in the brain, the degree of acute inflammatory response, and the age of the patient. 6,7,9,[11][12][13][14] Although NCC has been studied less in children than adults, there are age-associated differences in the clinical presentation and inflammatory response in the central nervous system. For example, hydrocephalus is frequent in adults and uncommon in children, and encephalitis is more frequent in children.…”

“…For example, hydrocephalus is frequent in adults and uncommon in children, and encephalitis is more frequent in children. 6,7,[9][10][11][12] The most important aspect of the pathogenesis of NCC is likely the inflammatory response in the brain. 9,11,[13][14][15] Its intensity has been associated with the number of cysticerci and their localization in the brain.…”

“…Thus, the reaction differs when cysticerci are found in the parenchyma, the subarachnoid space, and the ventricular system. 3,6,[9][10][11][12][13][14][15][16] Host-inflammatory mediators are important in the pathogenesis of severe parasitic diseases, such as malaria, leishmaniasis, and trypanosomiasis. [17][18][19][20][21][22][23][24] In the case of NCC, we have demonstrated by immunohistochemical analysis of brain tissue from adults with NCC that at least four types of immune responses against NCC (antibodies, NK cells, macrophage and neutrophil infiltration, and a combination of macrophages and T cells) may occur.…”